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It’s not commonly talked about, but many couples face unexpected hurdles when it comes to starting a family. Former first lady Michelle Obama is opening up about her own struggles to have children with former President Barack Obama.

In her new book “Becoming,” Obama says she felt “lost and alone” after experiencing a miscarriage 20 years ago. She underwent in vitro fertilization (IVF) to conceive her two daughters, Sasha and Malia.

Obama said she felt like a failure because people don’t talk about miscarriage or using IVF.

So how common is this type of journey into parenthood? We asked Dr. Christina Boots, assistant professor of obstetrics and gynecology specializing in reproductive endocrinology and infertility at Northwestern’s Feinberg School of Medicine.

Below, an edited Q&A with Boots.

Is infertility more common than we talk about or know about?

I think it is. It occurs in about at least 10 percent of the population. And I think most people aren’t talking about when they’re struggling. Whether they’re struggling and it just takes them longer or it happens on their own. Or whether they’re having to seek fertility treatment. There was a recent survey out that showed that 30 percent of the population either knows somebody who went through fertility treatment or went through it themselves. So I think it is happening a lot more often than anybody realizes.

So why do you think more people don’t talk about it?

I think it’s just like Michelle Obama says, that they feel like it’s a personal failure and they’re embarrassed and they’re disappointed and they’re sad and that’s hard to share. We all have a grandma and aunt who says if you would just relax it will just happen for you. So those kind of comments are not very helpful. So I think people don’t want to bring it up because they don’t want to deal with the reactions from family friends and the public.

Michelle Obama also revealed she had a miscarriage. And again, this is something that we don’t talk about a whole lot. How common are miscarriages?

They’re happening probably at least 20 percent of the time. So about 1 in 5 pregnancies are going to end in a loss. And I think until somebody goes through a miscarriage, they don’t really realize how often it’s happening. I hear a lot of patients say, I told my sister I just had a miscarriage and she told me she had one too and my mom told me she had two! So until it happens, people feel so isolated and alone and confused about it.

Michelle Obama was about 34 or 35 and she said, “the biological clock is real.” So is age a factor?

Absolutely. Most importantly I would say for egg quality because there’s just really nothing we could do about egg quality. So the older we get, the quality of our eggs start to decrease. But it’s also important that for egg quantity as well. So, as we age, we have fewer and fewer eggs. And when we do an IVF cycle, the second best predictor of success is how many eggs we can retrieve in an IVF cycle. So it goes from being around 50 percent when you’re less than 35 to about 5 percent when you’re in your early 40s.

Talk about the cost and the realities of those stresses for people in Illinois. What’s the cost? What’s covered?

Illinois is a unique state and it is what we call a mandated state. So companies that are based out of Illinois are required to have some fertility coverage. But, you know, not everybody who lives or works in Illinois is with a company that is based out of Illinois or there are certainly some loopholes in that as well. So we see in our practice everywhere from having absolutely no coverage at all to having four IVF cycles per year covered. Usually that’s typically the best plan that we’ll see. If you have absolutely no coverage, one IVF cycle runs around $15,000. So it’s a pretty significant expense. And even if you have some coverage, you know, some plans will give you a $20,000 lifetime max. So that seems like a lot of money but that might get you one IVF cycle, plus a little bit of an evaluation. But sometimes it takes more than one cycle. So certainly it makes the process and the treatment inaccessible for some couples, that’s for sure.

Do you think Michelle Obama’s revelations will help women talk and deal with their struggles?

I think so. I think the more women talk about it -- especially the powerful, strong, beautiful ones who make everything in life look so perfect and easy -- it really helps put things into perspective that it can be hard for anybody to conceive and it’s nobody’s fault. It’s just biology and a little bit of rotten luck sometimes. So I think some normalizing of it can be really helpful and just showing support that you’re not alone in this process, that lots of people had miscarriages and lots of people need help with getting pregnant with all of their children or just one of them or the first or maybe it’s the second. So yeah I think it’s going to be really, really helpful.